The Record

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October 2019
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Tell patients about possible noncoverage before providing service, treatment or item
If you and your patient decide that the best course of care for him or her may not be covered by Medicare Plus Blue^SM PPO, you’re required to inform the patient of possible noncoverage before performing the service or treatment or obtaining the item. Read more.

Inside this issue for you

See all the articles in this issue, grouped by category, below.

Professional

Changes to all Blue Cross Blue Shield of Michigan practitioner participation agreements announced
Mandated changes to Blue Cross Medicare Advantage PPO agreement announced
Register for AIM Specialty Health Prior Authorization Program webinar
Sign up today: New training webinars for providers and staff
Here’s when to bill for an originating site facility fee
Changes to reimbursement policy for board-certified behavior analysts take place Jan. 1
Blue Cross updates medical record requirements for applied behavior analysis services
Direct reimbursement available to clinical nurse specialists, beginning Jan. 1
We’ll be adding Evenity to the Medicare Part B medical drug prior authorization list
We’ll cover hemophilia drugs under the pharmacy benefit for most commercial members, starting Jan. 1
We’ll stop covering 500 mg Zytiga tablets starting Nov. 1
Save time, submit prior authorization requests electronically for pharmacy benefit drugs
Physical, occupational and speech therapy claims require appropriate modifier
2019 third-quarter CPT code updates
Categorization for outpatient physical therapy services changing in 2020
PCMH practices with care management services now identified in provider search tool
New, updated questionnaires have started opening in e-referral system
We’re discontinuing Reference Based Benefits offering Dec. 31
Update your Provider Authorization form when changes occur
Remind patients to get the flu vaccine
Coding corner: Documentation and coding for rheumatoid arthritis

Facility

Mandated changes to Blue Cross Medicare Advantage PPO agreement announced
Register for AIM Specialty Health Prior Authorization Program webinar
Sign up today: New training webinars for providers and staff
Here’s when to bill for an originating site facility fee
Blue Cross updates medical record requirements for applied behavior analysis services
We’ll be adding Evenity to the Medicare Part B medical drug prior authorization list
Physical, occupational and speech therapy claims require appropriate modifier
2019 third-quarter CPT code updates
Categorization for outpatient physical therapy services changing in 2020
We’re discontinuing Reference Based Benefits offering Dec. 31
Update your Provider Authorization form when changes occur
Skilled nursing facilities must follow CMS guidelines for issuing NOMNC forms to Medicare Advantage members
HMS concluded Medicare Plus Blue audits of skilled nursing facilities May 31
We’re resuming Medicare Plus Blue PPO place-of-service audits
Medicare Plus Blue PPO audits to use Sepsis-3 criteria

All Providers

Tell patients about possible noncoverage before providing service, treatment or item
Battling the opioid epidemic: A roundup of recent news and information
Oct. 10 is National Depression Screening Day
Updates to 2020 ICD-10 codes available
Billing chart: Blues highlight medical, benefit policy changes

Pharmacy

We’ll be adding Evenity to the Medicare Part B medical drug prior authorization list
We’ll cover hemophilia drugs under the pharmacy benefit for most commercial members, starting Jan. 1
We’ll stop covering 500 mg Zytiga tablets starting Nov. 1
Save time, submit prior authorization requests electronically for pharmacy benefit drugs

DME

L codes payable to DME providers

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